Self-employed farmer Sam Hawes, one of more than 25,000 Mainers who have signed up for coverage under the Affordable Care Act, says the law has reduced his out-of-pocket expenses by about 99 percent.
Hawes, 38, who owns a small Albion farm, Field of Greens, was paying about $650 each month in health insurance premiums as part of a package deal that included his parents and his brother. After initial hesitation, Hawes enrolled in a new plan a few weeks ago.
“Now, I pay six dollars and 27 cents a month,” he said. “And my coverage is better.”
But the same system that has benefited Hawes has only been a source of frustration to Sheila Webb, 51, of Moscow, who said Monday the experience has been horrible.
When an arm injury disabled her, she was forced to leave her job as a nurse at Redington-Fairview General Hospital in Skowhegan in 2007. Webb, whose workers compensation amounts to about $22,000 a year, was hoping to get a better deal than her current plan with Anthem Blue Cross Blue Shield, which costs $248 each month in premiums and has a $10,000 deductible.
In November, she walked into the emergency room with abdominal pain and walked out with a $2,500 bill.
Webb said she went to the Affordable Care Act’s website looking for help. Months later, Webb said, all she has to show for her efforts are three partially completed accounts on the website and a stack of notes that she took during more than five hours of telephone conversations with six different people.
Ultimately, Webb said she was pointed toward a gold platinum package that would cost $472 a month, but Webb said she couldn’t afford that. The response from a health official — “What makes you think you can’t afford that?” — left her embittered by the whole experience. She’s going to keep her existing plan.
“He was pushy, like a salesman,” she said. “I told him I know what I can afford.”
Overall, the consumer experience with the Affordable Care Act appears to have been mixed, said Joshua D’Errico, spokesman for Waterville-based HealthReach Community Health Centers, which has 11 clinics across western and central Maine, including in Franklin, Somerset and Kennebec counties.
The deadline for people to have acceptable health care coverage under the Affordable Care Act was Monday at midnight; those without health insurance may be hit with federal fines. Anyone who has started but not completed an application will be given extra time.
The deadline brought a week-long crush of people to HealthReach Community Health Centers, D’Errico said Monday. The centers’ small staff of educators have been devoting more and more of their time to helping people navigate the system. D’Errico said that even after they successfully sign up, many consumers are struggling to fully understand their rights and responsibilities.
“A lot of them haven’t had an option of affordable health care,” he said. “And for some, it’s a completely different world. â€˜What’s a premium? What do I have to report?’”
D’Errico said that, while the effort has been time-consuming for the staff, it’s also been extremely gratifying as they’ve helped under-served communities access the medical care they need. “They have been able to find some great options for folks,” he said.
Hawes said the notorious problems with the Affordable Care Act’s consumer website, combined with negative comments he’d heard about the health care law in general, discouraged him from applying right away.
“You hear all this stuff, you’re going to pay more,” he said.
Because Hawes makes about $16,000 a year, the premiums on his existing plan amounted to about half of his total income, and his parents paid the expense out of their pockets. Hawes said, the coverage wasn’t very good and had a deductible of $5,000. His wife, who was not included on the family plan, had no coverage at all.
With his parents paying so much out of pocket, and his wife uninsured, Hawes said he figured he had nothing to lose by enrolling. Now, he’s glad he did.
About 20 minutes after calling the national number, he said, he selected a plan that covered both him and his wife, with a deductible of $1,000. After mailing in proof of his income, he qualified for tax credits that reduce his monthly payments.
Moscow’s Webb, on the other hand, feels like she’s caught in a bad spot — she would like nothing more than to return to work, but her injuries prevent her from doing so. Because she can’t work, her finances are strained, but she doesn’t qualify for a reduced rate under the new legislation.
“It does anger me that I paid and paid and worked so darn hard and I’m not even eligible for, not even a break,” she said. “I don’t like the way it is, the world today.”
Henry Perkins was forced to sell Bull Ridge Farm, his small dairy business in Albion, after his hand was torn up in a combine in 2012. Unable to work, Perkins was forced to retire in his 60s, earlier than he would have liked, and was stuck with about $650 in monthly insurance premiums, along with a $5,000 deductible.
Perkins said the labyrinthine rules of the legislation were hard to navigate.
“I started in November,” he said.
Perkins persisted through many false starts, taking encouragement from the little successes he saw while shepherding his application through the bureaucracy and technical glitches.
“Every time I called up, I got a little further along the line.”
He took to calling at 3 a.m., because he knew the call volume would be lower and he wouldn’t have to wait as long. Even when he was finally accepted in mid-January, he said, his first claims were rejected, requiring another three weeks of work to resolve.
Now, he said, he’s paying so little he didn’t want to specify the amount.
“It’s pennies,” he said. “It’s kind of like a token payment.”
Perkins is now a big fan of the legislation.
He said most of those who are opposed to the health care act can afford their own insurance, and “it’s not made for them.”